Preventing Youth Violence May Cost Less Than You Think…

Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.

Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.

The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression(i.e., hit or punched someone, used a knife/gun against someone).

The reported cost estimates are based on an average adolescent volume for ED trauma centers. This $17 estimate is conservative, but adding even this amount to the average cost of an ED visit ($1,349) would raise the costs by only 1 percent. Our findings estimate the cost to prevent violence would fall between $3.63 and $54.96, using best and worst case scenarios.

Though the violence prevention intervention was not designed to eliminate future health care use, if it avoided one firearm-related hospitalization (mean charge $70,164), it would nearly pay for the entire annual cost of the intervention.

In the setting of health care reform and value-based care, coordinating efforts to offer proven preventive services wherever possible makes sense. Changing the way people think of the ED, and capitalizing on evidence will be key to optimizing each encounter in order to improve health and strengthen communities. For example, despite efforts to encourage patients to seek care in primary care settings and avoid the ED when possible, ED visits continue to outpace population growth. More than 15 million adolescents visit the ED annually, and in an urban ED more than 75 percent of patients screen positive for violence. Therefore, the ED may be an optimal setting to target high priority problems like youth violence, specifically amongst patients known to frequent the ED.

Based on our findings, costs should not pose a legitimate barrier to prevent most pediatric trauma centers from adopting ED youth violence prevention programs.